Rural/Urban Differences in Missed Opportunities for Identification of HIV-Infected Individuals in South Carolina Transmission of human immunodeficiency virus (HIV) continues to be a problem in the US, even after years of research and prevention efforts. The Centers for Disease Control and Prevention (CDC) recently published new guidelines recommending routine HIV screening in healthcare settings for all individuals, regardless of risk. These changes are based on evidence that former guidelines for risk-based testing failed to identify a large proportion of HIV-infected individuals. Many are either diagnosed late or remain unaware of their infection because they are not being tested, even though they are accessing healthcare services many times prior to their diagnosis. These healthcare encounters represent missed opportunities for earlier identification of HIV infection. Increasing incidence of HIV in certain areas of the US is also a problem. Evidence shows that the South caries a disproportionate burden of HIV, which is concentrated in women and minorities, and in the rural areas of these states. Rural areas already face many unique health challenges, increasing the burden that HIV places on their healthcare systems. South Carolina (SC) offers a unique opportunity to study both the rural HIV/AIDS epidemic in the South and missed opportunities for identification of HIV-infected individuals. SC has consistently ranked in the top 10 nationwide for annual AIDS incidence since 1998. Furthermore, approximately 40% of the population of SC is rural. SC has a well-established HIV/AIDS Reporting System and a unique statewide healthcare discharge database. These databases will be used to link HIV diagnoses with prior healthcare encounters to investigate the main objectives for this study. The overall objectives are to assess whether degree of urbanization of an individual's place of residence at diagnosis leads to increased risk for being a late tester or an increased risk of missed opportunities for earlier HIV diagnosis. This proposal is in response to at least one of the CDC's Health Protection Goals, Healthy People in Every Stage of Life, as it investigates health disparities among HIV- infected rural residents of SC, of which a large majority are minorities. [unreadable] [unreadable] [unreadable] [unreadable]